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Promoting Quality Health Care for All
The Record | The Challenge | The Plan | The Opportunity
THE RECORD
For decades the Institute of Medicine (IOM) of the National Academies has taken on the most important issues affecting health, longevity, and quality of life. Many of those issues have been controversial, and objectivity has been paramount. Neither the challenge of AIDS nor the spiraling rate of unwanted pregnancies gained broad attention from policymakers until the Academies presented facts on the issues instead of moral judgments. More recently, a landmark report on teen smoking set the terms for current discussions of tobacco use by adolescents. And reports on breast implants and medical uses for marijuana have set a scientific baseline for policy decisions.
Drawing on experts in the fields of medical care, public health, law, pharmaceutical research and development, health education, and health care administration, the National Academies have provided policymakers with objective, authoritative guidance on difficult and challenging issues such as --
- Quality of medical care -- A groundbreaking IOM study on deaths due to medical errors led to almost immediate action by the President and Congress to improve federal oversight of health care quality in the United States. And a comprehensive review of cancer care delivery in the United States explored how lack of medical coverage, socioeconomic status, physician decision making, and patient beliefs can all interfere with cancer patients receiving optimal care. The review commit-tee made specific recommendations on monitoring, measuring, and extending quality care to all cancer patients.
- Safety of silicone breast implants -- Experts assembled by the IOM reviewed the history and chemistry of silicone breast implants and explored evidence on the safety of these devices. Their final report noted the high incidence of local complications following implantation, but found no evidence of systemic effects.
- Distributing donor organs for transplant --With organ transplantation an increasingly common procedure -- and donor organs relatively scarce -- the IOM assessed the effectiveness and equity of national organ procurement policies. Its recommendations, which included making donated organs available across broader geographic areas, led to proposed changes in federal donor organ policies.
- The health care needs of uninsured children across the nation -- To facilitate progress on the State Children’s Health Insurance Program’s multiple and often competing objectives, the IOM studied the detailed relationship between health insurance coverage and children’s access to care. That study identified important insurance and health care delivery trends that may affect care for uninsured and underserved children and recommended specific actions to promote federal accountability.
- Strategies for vaccine development in the 21st century -- After eradicating smallpox, nearing elimination of polio, and reducing the threat of whooping cough, measles, and meningitis, where do vaccine researchers and developers turn their attention? To address that question, experts convened by the IOM examined the lessons of the polio experience, the scientific advances that have set the stage for new vaccines, the factors that affect how vaccines are used in the population, and ethical cost-benefit questions. The group then developed an analytical framework and quantitative model that will be used for setting vaccine development priorities in the coming decades.
- Evaluating family violence interventions -- The Institute of Medicine coordinated the first systematic analysis of interventions, examining the impact of victim support and assistance programs and the penalties and treatments for offenders. The resulting recommendations will guide programs, policies, and practices in health care, law enforcement, and social service settings across the nation.
- Developing science-based dietary and nutritional guidelines -- Reports of the Food and Nutrition Board (FNB), established in 1941, have led to improved nutrition by specifying Recommended Dietary Allowances (RDAs) of essential nutrients. And the FNB coordinated the first comprehensive survey of the links between nutrition and disease, resulting in a guide to reducing the risks of heart disease and cancer through diet.
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THE HEALTH CARE CHALLENGE
Powerful social, political, and economic forces buffet national health care systems. Even as researchers announce significant new discoveries and clinical applications, concern mounts over the structure and goals of the core health care delivery system. Most disconcertingly, the rolls of the uninsured continue to climb, the cost of health care resumes its upward movement, and many people are beginning to question the underlying quality of the health care provided to them.
How can a family know that the hospital they choose will provide quality care? When new infections arise, will there be antibiotics to fight them? Can we save children from the ravages of cancer by keeping them from smoking? Are we prepared to meet the financial and clinical challenges posed by an aging population and the ethical questions posed by end-of-life decisions?
Science, government, and society together shape the answers to these and other pressing questions.
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THE PLAN
In assessing the state of health care in the United States and globally, the National Academies have identified these clear and important goals for their work advising health policymakers on the health care system of the 21st century --
- Helping maintain and improve the health and well-being of the entire population by moving health care quality to the top of the policy agenda and by guiding policymakers to increase accountability for the outcome of care and for the way that outcomes are measured.
- Initiating studies on the health, economic, and social impact of the rising number of uninsured Americans.
- Studying opportunities and mechanisms to improve care of the elderly and of children.
- Continuing to serve as the nation’s primary source of reliable scientific guidance on food, nutrition, and a healthful diet and focusing attention on the safety of the food supply and the control of food-borne illnesses.
- Assisting health professionals develop effective disease and injury prevention strategies and proposing new initiatives that apply knowledge from the fields of social and behavioral sciences to public health goals and problems.
- Focusing on programs to reduce the number of victims of violence, drug abuse, and malnutrition.
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THE OPPORTUNITY TO SHAPE THE FUTURE
The National Academies need your assistance to implement their plans for meeting the Health Care challenge. You might consider --
- Endowing an annual forum -- attended by policymakers, health care professionals, and journalists -- to identify the most important emerging challenges to the U.S. health care delivery system ($2 million endowment).
- Funding the work of IOM Scholars, who would lead in-depth analyses of policies on cancer care and research, health promotion and disease prevention, the health needs of women and families, health care for a growing generation of older Americans, and the field of health and human rights ($100,000 annually).
- Underwriting the creation and nationwide distribution of practical handbooks and guides developed out of the IOM’s more in-depth studies, such as the recent publications Information for Women About the Safety of Silicone Breast Implants and Working Together: We Can Help People Get Good Care When They Are Dying. ($25,000 per publication).
As the defined needs change and our programs evolve, so too will your opportunities to help. To learn about more ways you can shape the future through the work of the National Academies, visit the Giving Opportunities page or contact us at giving@nationalacademies.org. We welcome your ideas, too.
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_______________ T h e . P l a n . f o r . t h e . F u t u r e _______________
Providing Information for a Free Society
Educating Our Children
Protecting the World's Resources
Promoting Quality Health Care for All
Prospering in the 21st-Century Economy
Securing a Safer World
Guiding Science, Engineering, and Medicine 
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